Abstract P4-13-02: Exclusive fat grafting breast reconstruction after mastectomy: Aesthetic results, satisfaction and quality of life evaluation on 38 patients

Background: Autologous fat grafting has become a frequent, simply reproducible and low-risk technique in breast reconstruction. The potential risk of fat tissue transfer to the breast for oncologic patients remains to be discussed, but one must clearly distinguish the situation where there is a breast parenchyma left and where the whole gland has been removed, like in our study. Although lipotransfer has become very popular, only a limited number of case series have been reported up to date. The presented study evaluates aesthetic results and quality of life after exclusive fat grafting breast reconstruction.

Patients and methods: A retrospective study was performed in two French centers with five surgeons between February 2011 and June 2015. We included patients with prior breast cancer, treated by mastectomy and with a finished breast reconstruction with exclusive fat grafting. We excluded patients with implant or flap. For each patient, the aesthetic evaluation was threefold, performed by the patient, the surgeon and an extra person, using the same questionnaire. For the analysis of the cosmetic results, the patients, surgeons and the other person were asked to grade the result on a 0 to 10 scale, ranging from "very bad" to "very good". They were questioned about the global esthetic result, symmetry between the two breasts and reconstructed breast texture. Satisfaction was evaluated using a Breast-Q adapted questionnaire, elaborated by psycho-oncologists and surgeons. Quality of life was evaluated using WHOQOL-BREF 26. Statistical analysis was performed using stata 13.1 SE.

Results: We sent a questionnaire to 48 patients and we obtained 38 responses. The mean age of the patients was 52 years, 31 patients (81,6%) lived in couple and 29 patients (76,3%) were employed. We performed 190 fat grafting procedures with an average of 4,2 per patient. The mean total quantity of fat injected was 904 ml per patient with a mean quantity per procedure of 219 ml. The mean time between two procedures was 4,3 months. The average grade obtained for the global esthetic result was 7,3 +/- 1,8 out of 10 for patients, 7,6 +/-2 for the extra person and 7,9 +/- 1,4 for surgeons. For symmetry between the two breasts, the result was 7,1 +/- 1,9 and for the texture, it was 6,8 +/- 2,6. To the question "did the final result meet your expectations?” 81,5% (31/38) of the patients and 79% (30/38) of the surgeons said yes. Among the 29 patients having a professional activity, 86% (25/29) of patients were able to work between each fat grafting session. The handicap evaluation in the professional life for these patients from 0 "no handicap "to 10 " important handicap” showed a score of 2,24 +/-2,7. As for global quality of life evaluation, to the question: "how would you grade your quality of life?" 92,3 % (35/38) of the patients answered "good" or "very good" (vs. 72,0 % in the general population - p = 0.004).

Conclusion: Autologous fat grafting can be offered as a good alternative for total reconstruction after mastectomy with good aesthetic results and no deleterious impact on quality of life.

Citation Format: Bordes V, Simorre M, Campion L, Lejeune F, Loirat Y, Dravet F, Bouffaut A-L. Exclusive fat grafting breast reconstruction after mastectomy: Aesthetic results, satisfaction and quality of life evaluation on 38 patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-13-02.

Abstract P3-14-04: Exclusive fat grafting breast reconstruction after mastectomy: Feasibility and complications on 54 patients

Backgrounds: Autologous fat grafting has become a frequent, simply reproducible and low-risk technique in breast reconstruction. The potential risk of fat tissue transfer to the breast in oncologic patients remains to be discussed, but one must clearly distinguish the situation where there is a breast parenchyma left and where the whole gland has been removed, like in our study. Although lipotransfer has become very popular, only a limited number of case series have been reported up to date. The presented study describes an optimized treatment and complications for breast reconstruction after total mastectomy by lipotransfer alone.

Patients and methods: A retrospective study was performed in two French centers with five surgeons between February 2011 and June 2015, including 54 patients. Inclusion criteria were patients with prior breast cancer, treated by mastectomy and with a finished breast reconstruction with exclusive fat grafting. Exclusion criteria were prior reconstruction with implant or flap. We used two technics for liposuction: manual aspiration with syringes (pouret kit®) or waterjet assisted liposuction (body-jet®). The BRAVA® could be combined with the reconstruction. Our study had 2 main objectives: evaluate the factors influencing the number of surgical procedures and study the complications and carcinologic evolution. Statistical analysis was performed using stata 13.1 SE.

Results: We included 54 patients, 49 delayed reconstructions including two bilateral reconstructions and 5 immediate reconstructions. The morphologic data showed: a normal BMI for 70,3 % (38/54) patients and a bra cup A or B for 72,2 % (39/54). 39 patients had radiotherapy during the cancer treatment and the mean time between radiotherapy and reconstruction was 19 months. For the patients without radiotherapy, the mean time between mastectomy and reconstruction was 22 months. 6 patients (11%) were smoker or diabetic. We used manual aspiration in 37 patients (68,5 %) and hydro dissection in 17 patients (31,5%). 10 patients received BRAVA system in complement. We performed 231 fat grafting procedures with an average of 4,2 per patient. The mean total quantity of fat injected was 904 ml per patient with a mean quantity per procedure of 219 ml. The mean time between two procedures was 4,3 months. Only the prior radiotherapy treatment increases the number of fat grafting procedures significantly (p=0,02) and the use of hydro dissection with bodyjet decreases the number of fat grafting procedures significantly (p=0,04). We observed one failure of procedure requiring an implant and three patients with metastatic disease without local recurrence with a mean follow of 5, 2 years. We also observed 3% of infectious complications (7/231) and 19 patients presented fat necrosis (34%). Of these 19 cases of fat necrosis, 6 (11 %) required a surgery.

Conclusion: Autologous fat grafting can be proposed as an alternative for total reconstruction after mastectomy with a low level of complications and no local recurrence in our study. Only anterior radiotherapy increases the number of procedures probably due to fibrosis and lack of cutaneous flexibility.

Citation Format: Bordes V, Campion L, Lejeune F, Loirat Y, Boiffard F, Brillaud-Meflah V, Dravet F, Bouffaut A-L. Exclusive fat grafting breast reconstruction after mastectomy: Feasibility and complications on 54 patients [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-14-04.

[Covering of a thoraco-lumbar defect by omentoplasty]

With a case of thoraco-lumbar defect, the authors discuss about different procedures to cover it. In this place, the better procedure is certainly the latissimus dorsi flap, in all combinations. The indication for omentoplasty at this spinal site should not be performed by first intention but by exclusion of other procedures, as in the case considered by the authors. It was a 37-year-old man, paraplegic from the age of 16, with a deep chronic spinal wound, secondary to sepsis of a posterior segmental fixations. A staphylococcus aureus infection which developed as a surgical complication was initially treated with antibiotics and surgical cleaning procedures without removing instrumentation. However, the infection remained active and the material was finally removed. Spinal immobilisation was strengthened by external fixation. The area was cleared of all suspect material, including bone graft, leaving a wide back-wound open to the spine. Spontaneous healing was first attempted, but the size and the chronicity of the wound led us to use pedicled greater omentum to close the defect. The omentum was pedicled on the right gastroepiploic vessels and transferred to the back wound through the posterior abdominal wall muscles, next to the right kidney. This procedure allows rapid healing. In association with suitable antibiotics, it has prevented any recurrent infection after 18 months of follow-up. It was no feasible to cover the wound with a latissimus dorsi flap, considering the importance of this muscle in the movements of a paraplegic and considering the initial impossibility of removing the external fixation.

[Large abdominal wall reconstruction by free flap after recurrence of a dermatofibrosarcoma protuberans]

Based on a case of recurrence of a dermatofibrosarcoma protuberans of the abdominal wall, the authors discuss the need for initial wide resection of this type of skin tumour and the possibilities of repair of extensive full thickness defects of the abdominal wall by means of a latissimus dorsi myocutaneous free flap.